Provider Demographics
NPI:1487658829
Name:MEYER, THOMAS L (MD)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:L
Last Name:MEYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25080 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-1740
Mailing Address - Country:US
Mailing Address - Phone:313-730-8880
Mailing Address - Fax:313-730-1167
Practice Address - Street 1:25080 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-1740
Practice Address - Country:US
Practice Address - Phone:313-730-8880
Practice Address - Fax:313-730-1167
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITM049591207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI195245910Medicaid
MI160009592OtherMEDICARE RAILROAD
MIA74089Medicare UPIN
MI195245910Medicaid